“Minor Brain Injury” Is Often an Oxymoron

Insurance company representatives often seize upon the term “minor brain injury” to devalue what is too often a life-altering event. They are eager to ignore post-concussion syndrome until vigorous representation forces them to deal with it.

While many people do seem to fully recover from an isolated occasion of “getting their bell rung” with a concussion in sports or accidents, many others never fully recover. The combination of “minor” with “brain injury” is thus often an oxymoron (a figure of speech in which apparently contradictory terms appear in conjunction). No brain injury that has a continuing effect on- you or a loved one is truly minor.

A standard medical definition says that a patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by at least one of the following:

1. any period of loss of consciousness;

2. any loss of memory for events immedi­ately before or after the accident;

3. any alteration in mental state at the time of the accident (eg, feeling dazed, disori­ented, or confused); and

4. focal neurological deficit(s) that may or may not be transient;

but where the severity of the injury does not exceed the following:

• loss of consciousness of approximately 30 minutes or less;

• after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and

• posttraumatic amnesia (PTA) not greater than 24 hours.

This definition includes: 1) the head being struck, 2) the head striking an object, and 3)behavioral change(s) and/or alterations in degree of emotional responsivity (eg, irritability, quickness to anger, disinhibi­tion, or emotional lability) that cannot be accounted for by a psychological re­ action to physical or emotional stress or other causes.

It is also well-known that sudden deceleration, causing the brain to bounce around inside the skull, can cause brain damage even without a direct external impact to the head. However, insurance company representatives still argue that brain injuries are not credible without an external injury to the head and documented loss of consciousness. It takes vigorous, knowledgeable representation to drive this home.

A consensus statement of rehabilitation physicians recognizes that patients may not become aware of, or admit, the extent of their symptoms until they attempt to return to normal functioning. In such cases, the evidence for mild traumatic brain injury must be reconstructed. We have seen that many times. 

Mild traumatic brain injury may also be overlooked in the face of more dramatic physical injury (e.g., orthopedic or spinal cord injury).

“Minor” brain injury often has disinhibition effects, leading to impulsive, aggressive, or risk-taking behavior, particularly regarding driving, alcohol and drug use, and sexual conduct. All of that is destructive and can further contribute to a downward spiral of life.

Those behavioral changes are far from minor. They can ruin marriages, families and careers. They can plunge a person into a downward spiral of depression, hopeless despair, alcohol and drug abuse, and early death.

In recent years, we have all become more aware of the devastating cascade of destructive consequences of concussions in war veterans, football players, and ordinary people.

We have seen, both in law practice and among friends and loved ones, how “mild” brain injuries were initially overlooked or minimized but turned out to have immensely destructive effects.

The ripple effects of “minor” brain injury can be fatal. A man I knew had an accident that caused what initially appeared to be a trivial brain injury. But this brilliant, highly successful man lost the mental sharpness that had given him a great competitive advantage in business. He no longer had a rapid recall of names, numbers, dates, and details as before. Most people around him did not notice the change as he maintained a gregarious facade. However, recognizing what he had lost, he slid into a deep depression and within a few years took his own life.

A woman who was in a violent motor vehicle crash had surprisingly little physical injury but over the next few hours began to experience headaches, confusion and low-grade seizure activity. Eventually, the progression of occasional seizures led her to be barred from driving and the loss of a side business that gave her much personal satisfaction as well as income. She will be required to take anti-seizure medications for the rest of her life.

We have successfully represented many clients with so-called “minor” brain injuries and post-concussion syndromes. If you or a loved one have suffered such a brain injury, call us at 404-253-7862.

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Johnson & Ward has been a leading personal injury and wrongful death specialty law firm in Atlanta since 1949. The founders of the firm were also among the founders of the Georgia Trial Lawyers Association. Current partners include former presidents of the State Bar of Georgia and the Atlanta Bar Association.